Better obstetric outcomesBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3778 (Published 15 June 2011) Cite this as: BMJ 2011;342:d3778
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Role of traditional birth attendants in reducing maternal morbidity and mortality in developing countries.
Obstetric fistula is a devastating condition affecting nearly two
million women in the developing countries (1). Lack of skilled birth
attendance has been citied as an important factor leading to delay in
recognizing obstructed labour and seeking medical help. Governments are
promoting institutional deliveries as a means to reduce maternal morbidity
and mortality. Cash incentives to women, health workers and /or facilities
to increase institutional deliveries have been harnessed besides various
IEC activities. In India, a cadre of accredited social health activists
(ASHAs) are given monetary incentives to encourage early antenatal booking
and institutional deliveries (2). However, the traditional birth
attendants or 'dais' have not been given any role. In many parts of our
country, health services are not easily accessible and strong cultural
beliefs exist in favour of home births. The decision of 'dais' and other
household members override the decision of the skilled birth attendants
during home births (3). It is thus important to engage the traditional
birth attendants as they are an important part of society and enjoy
respect and trust of the families they serve (4). Their skills should be
enhanced about when and where to seek help and importantly what 'not to
do' in labour. Besides this, health managers should also be wary of the
rise in iatrogenic fistulas developing at the hands of inadequately
trained providers performing caesarean sections and gynaecological
1. Murray C, Lopez A. Health Dimensions of Sex and Reproduction, Geneva:
World Health Organization; 1998.
2. Ministry of Health and Family Welfare, Government of India 2006. Janani
Suraksha Yojana : Features & Frequently asked questions and answers.
http://mohfw.nic.in/WriteReadData/l892s/file28-99526408.pdf (accessed on
June 20th, 2011).
3. Iyengar SD, Iyengar K, Martines JC, Dashora K, Deora KK. Childbirth
practices in rural Rajasthan, India: implications for neonatal health and
survival. Journal of Perinatology 2008; 28: S23-S 30.
4. Entering dais' world. Jeeva pilot project report. New Delhi: June 2010.
accessed on June 20, 2011.
5. Singh S, Chandhiok N, Dhillon BS. Obstetric fistula in India: current
scenario. Int J Urogynecol 2009; 20: 1403-5.
Competing interests: No competing interests